A SIMPLE GUIDE TO UNDERSTANDING MEDICARE. Courtesy of. A Simple Guide to Understanding Medicare

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Kristopher Ellis
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1 A SIMPLE GUIDE TO UNDERSTANDING MEDICARE Courtesy of

2 WHAT IS MEDICARE? Medicare is a federal health insurance program started in 1965 and administered by the U.S. Centers for Medicare & Medicaid Services. At present, Medicare provides coverage for nearly 50 million Americans. MEDICARE IS DESIGNED FOR: People age 65 or older. People under age 65 with certain disabilities. People of all ages with permanent kidney failure.

Centers for Medicare & Medicaid Services.

3 HOW IS MEDICARE ORGANIZED? MEDICARE IS DIVIDED INTO FOUR PARTS: Part A covers hospital bills (as well as skilled nursing facilities, hospice and home healthcare, in certain situations). Part B covers doctor bills and other outpatient care. Part C (also called Medicare Advantage) is an optional program offered by private insurance companies that contract with Medicare to provide coverage for Part A, Part B and sometimes Part D benefits. Medicare pays the plans a fixed amount per enrollee to provide services. Specifics of these plans vary by provider. Part D provides prescription drug coverage. Part D is also offered through Medicare-approved private insurance companies. Parts A and B are sometimes referred to as Original Medicare. Enrollment in Part B is voluntary and requires a monthly premium. A Medicare beneficiary may choose to obtain Medicare benefits through a Medicare Advantage plan (Part C) rather than Original Medicare. Part D is an optional add-on that also requires payment of premiums.

Part C (also called Medicare Advantage) is an optional program offered by private insurance companies that contract with Medicare to provide coverage for Part A, Part B and sometimes Part D benefits.

4 WHO IS ELIGIBLE FOR MEDICARE? Medicare is open to U.S. citizens and legal permanent U.S. residents. In general, one must have 40 quarters (10 years) of payroll tax contributions on record to receive Medicare. However, certain individuals who have not made the required payroll tax contributions may also qualify, for example, based on their spouse s payroll tax contributions, disability or by purchasing Part A benefits. HOW MUCH DOES MEDICARE COST? Medicare Part A coverage is provided at no cost to you, since it is funded by payroll taxes paid by you and your employer during your working years. However, Medicare does not cover 100 percent of your medical costs. People enrolled in Original Medicare must pay deductibles and co-payments, which can be significant. In 2016, Medicare Part B premiums will vary based on income with premiums starting at $ per month. The Part B deductible for 2016 is estimated to be $223 per year. These rates are subject to change each year and varies based on individual circumstances. If you choose Part C rather than Original Medicare, there may be a premium in addition to the Part B premium. You also pay a monthly premium for Part D drug coverage. Rates vary according to the plans you choose.

However, certain individuals who have not made the required payroll tax contributions may also qualify, for example, based on their spouse s payroll tax contributions, disability or by purchasing

5 WHEN CAN I ENROLL IN MEDICARE? If you receive Social Security benefits, you automatically receive Part A and Part B coverage starting the first day of the month you turn 65. Otherwise, you must sign up during the Initial Enrollment Period, which starts three months before you turn 65 and lasts for seven months, or during subsequent Enrollment Periods (January 1-March 31). In some cases, such as people covered under a group health plan based on current employment, a special enrollment period may apply. If you are enrolled in a Medicare Advantage plan, during the Open Enrollment period you can make choices about your Medicare services for the following year. Open Enrollment is October 15 through December 7. The choices you make during that period go into effect January 1, 2016.

31). In some cases, such as people covered under a group health plan based on current employment, a special enrollment period may apply.

6 DOES BAPTIST HEALTH PROVIDE SERVICES TO MEDICARE? Baptist Health participates in Original Medicare and in Medicare Advantage HMOs offered by leading insurance companies, including AvMed, Coventry*, Florida Blue and Medica. Baptist Health South Florida is a private, not-for-profit healthcare organization. With seven hospitals and more than 40 outpatient facilities spanning three counties, we are proud to be the largest healthcare provider in the region. Baptist Health also includes Baptist Health Urgent Care, Baptist Health Primary Care, Baptist Health Medical Group and Baptist Health Quality Network physicians. Exceptional care is provided at: Baptist Hospital Baptist Children s Hospital Doctors Hospital Homestead Hospital Mariners Hospital (Monroe County) South Miami Hospital West Kendall Baptist Hospital For a full list of Baptist Health services and locations, please visit BaptistHealth.net. For a full list of the plans and which Baptist Health entities participate, call us at or visit BaptistHealth.net/InsurancePlans. *Baptist Health does not participate with Coventry Summit.

Baptist Health South Florida is a private, not-for-profit healthcare organization.

7 HOW DO I CHOOSE A MEDICARE ADVANTAGE PLAN? The official Medicare website, Medicare.gov, provides a list of every plan available in your area as well as objective measures of the quality of care they provide. If you are accustomed to using Baptist Health physicians, hospitals and other Baptist Health facilities, look carefully at the plan s network to ensure Baptist Health is included. WHAT IS MEDICARE SUPPLEMENTAL OR MEDIGAP INSURANCE? HOW IS MEDICAID DIFFERENT FROM MEDICARE? Many private insurance companies offer policies that pay some healthcare costs not covered by Original Medicare (for example, co-payments, deductibles and medical care when you travel outside the U.S.). Medigap coverage is available only to people covered by Original Medicare. Medicare Advantage plans often offer options for lower co-payments or greater benefits that make Medigap unnecessary. Medicaid is a healthcare assistance program that is funded by federal and state governments. It provides health benefits for low-income people who might otherwise go without medical care for themselves and their children. Each state administers its own Medicaid program. If a person is covered by both Medicare and Medicaid, Medicaid may cover Medicare premiums, deductibles, co-payments, co-insurance and/or some services or items Medicare does not cover.

If you are accustomed to using Baptist Health physicians, hospitals and other Baptist Health facilities, look carefully at the plan s network to ensure Baptist Health is included.

8 WHERE CAN I GET MORE INFORMATION ABOUT MEDICARE? The official U.S. government website for Medicare, Medicare.gov, provides useful information and allows enrollees to manage their coverage and claims information online. The site also provides access to the official Medicare handbook, Medicare & You, which is updated every year in December. This handbook provides a summary of Medicare benefits, coverage decisions, rights and protections, and answers to the most frequently asked questions about Medicare. You may order a hard copy or download a PDF or e-reader version of Medicare & You from Medicare.gov (click Forms, Help & Resources). The handbook is available in English, Spanish, Braille and large print, as well as on an audio CD. SHINE (Serving Health Insurance Needs of Elders) is a free program offered by the Florida Department of Elder Affairs and your local area agency on aging. Specially trained SHINE volunteers can assist you with your Medicare, Medicaid and health insurance questions by providing one-on-one counseling and information. SHINE services are free, unbiased and confidential. Call ELDER ( ) or visit FloridaShine.org. Learn more about Medicare plans that include Baptist Health, Baptist Health Medical Group and physicians who participate in the Baptist Health Quality Network at or BaptistHealth.net/InsurancePlans. This publication is for educational purposes only. Medicare has neither reviewed nor endorsed its content. Request additional information from Medicare before making decisions about your coverage.

The site also provides access to the official Medicare handbook, Medicare & You, which is updated every year in December.

What is a Medicare Advantage Plan?

CENTERS FOR MEDICARE & MEDICAID SERVICES What is a Medicare Advantage Plan? A Medicare Advantage Plan (like an HMO or PPO) is a way to get your Medicare benefits. Unlike Original Medicare, in which the